Trauma Susceptibility and the TCM Response
The American Psychological Association estimates that 70% of adults will experience at least one traumatic event in their lifetime. One in five trauma survivors will develop symptoms consistent with the diagnosis of PTSD, the majority of them will be women. Clinical manifestations of this disorder include flashbacks and nightmares, anxiety, intrusive memories and hyper arousal. But not all traumatic events are created equally. Rape, for example, carries a much higher potential for developing PTSD. It is estimated that 50% of all sexual assault victims report symptoms associated with post-traumatic stress. The 2017 World Health Organization mental health survey concluded the highest burden for PTSD to be among those who reported exposure to sexual trauma. Additionally adults who experience abuse as children may be at a higher risk of developing PTSD into adulthood. A 2019 large scale, cross-sectional Chinese study found that long-term exposure to Adverse Childhood Experiences (ACEs) greatly increased the participants propensity toward post traumatic stress disorder, depression and risky behaviors like substance abuse. Although the scope of ACEs is too broad to address within the context of this article it’s worth mentioning here that the effects of trauma appear to be both time and dose- dependent, suggesting there are “sensitive periods” in development where traumatic events are more influential in the development of PTSD as an adult. A 2019 survey found lifetime stressors and adverse childhood experiences as predictive of symptoms associated with trauma and stress-related disorders.
Combat trauma is also associated with an increased risk of developing the disorder. A 2017 cohort study of 5,826 American combat veterans revealed a 6% higher prevalence of PTSD than that of the general population. Not surprisingly this military population is 2-4 times more likely to a develop a substance use disorder, a common comorbidity of PTSD. Other high quality studies estimate the risk for developing SUD double in those with a concurrent diagnosis of PTSD. Current PTSD-SA (Substance Abuse) research puts forward the self-medication hypothesis which asserts that substance abuse alone can be a determinant for exposure to trauma as a consequence to risky behavior like gang activity and violent acts committed while under the influence of intoxicants. What’s more, a PTSD diagnosis can be a predictor of outcomes in the treatment of substance abuse issues essentially reducing the efficacy of these interventions. Current neurobiological research utilizes the developmental-learning model to explain how early childhood learning may be disrupted by an environment of chronic stress which may alter the development of neural connections that lead to addiction. This may help explain why some are predisposed to PTSD-SA after exposure to trauma.
In addition, the effects of trauma may also be heritable. The gene-environment correlation hypothesis states that environment and potential for exposure to trauma are determined in part by genetic factors. Current epigenetic research in several animal studies identified alterations in DNA resulting from exposures to trauma during pre-natal and natal phases of development. In fact a 2018 meta-analysis of PTSD-related biomarkers suggests that epigenetics may be a key characteristic in determining those who suffer from the disorder and those who do not. In 2009 genetic researchers Yehuda & Bierer concluded that epigenetic mechanisms may help explain the significance of family history relational to vulnerability to PTSD. Although no specific genes have been identified, the role of DNA methylation in PTSD has the potential to fuel novel approaches to PTSD treatment. Increased understanding of changes in gene expression under the context of trauma exposure in addition to further research may lead to the discovery of important biomarkers predictive of PTSD and the development of better treatment options for patients. As well, early identification of these signature expressions may enable preventative care strategies for PTSD in the future.
The Traditional Chinese Medicine Response
Despite the myriad of trauma research available, there is a relative lack of evidence to suggest TCM may be helpful in the treatment of PTSD. That is not say the role of TCM interventions in the continuum of trauma response treatment is not promising. Our medicine, although ancient, lends insight to novel approaches to PTSD treatment currently being studied. In 2018 the International Society of Traumatic Stress Studies (ISTSS) guideline referenced acupuncture as a non-pharmacological intervention with emerging evidence for the treatment of PTSD. An earlier systematic review on Complementary and Alternative Medicine (CAM) for PTSD symptoms rated acupuncture the second-most effective intervention behind Trans-magnetic Stimulation (TMS). A 2015 randomized control trial (RCT) acupuncture was shown to be as effective as Cognitive Behavioral Therapy (CBT) in treating PTSD symptoms compared to a waitlist control. What’s more is that acupuncture may also potentiate the effects of CBT in the treatment of PTSD, although presently there are no high quality studies available to reference. Despite this, results from meta- analyses indicate positive effects from acupuncture intervention. There is also anecdotal evidence to suggest efficacy of acupuncture in the treatment of combat PTSD amongst active duty service members using the auricular trauma protocol (ATP) for nervous system regulation when evidence-based interventions like exposure therapy are not feasible. Additionally, mind- body exercises like tai chi and qi gong have been found to be beneficial in a broad range of PTSD- affected populations demonstrating reduction of stress and improvement of health outcomes among individuals with PTSD.
Adding to a growing body of research, a 2015 article published in the Journal of Family & Community Health draws on contemporary research that associates patient-centered care models with increased patient retention and engagement suggesting the need for trauma- informed training at the graduate level for all healthcare providers. Trauma- informed care (TIC) is an evidence-based healthcare delivery model that seeks to actively prevent re-traumatization within patient populations as well as manage “burnout” and compassion fatigue amongst healthcare providers. This holistic approach considers the “qi” of its stakeholders and the influential patterns most often seen in a trauma care setting. Groups like the People’s Organization of Community Acupuncture (POCA) infuse TIC with “liberation acupuncture”, a philosophical approach to the medicine “that affirms that individual health and disease do not exist, and cannot be understood or addressed, apart from social conditions – particularly injustice, inequality, and the pervasive influence of traumatic stress. This socially conscious approach utilizes a cooperative model of trauma- informed care for patients and practitioners alike, expanding community acupuncture services into underserved communities. The POCA Tech training program provides acupuncture students an opportunity to receive a master’s level certification in acupuncture and the ability to own and operate their own POCA Co-op clinic upon completion of the program.
The National Acupuncture Detoxification Association (NADA) offers licensed acupuncturists the opportunity to become Acupuncture Detoxification Specialists (ADS) certified in the NADA protocol which targets SUD by helping to regulate the nervous system. Additionally, ADS trainers provide NADA education to mental health specialists, nurses, medical doctors and first responders thus expanding access to TCM interventions in populations affected by trauma. Acupuncturists Without Borders offers a 5-part trauma-informed care certification for providers which covers the TCM perspective on the physiology of PTSD, approaches to trauma recovery as well as leadership skills through trauma-informed facilitation. AWB is known for empowering practitioners to become community organizers able to respond to trauma-associated events like natural disasters by establishing ad-hoc acupuncture clinics equipped to respond to the needs of communities in crisis. AWB guest lecturer and licensed acupuncturist Alaine Duncan, in her book The Tao of Trauma, marries biomedical research with Acupuncture and Asian Medicine (AAM) principles in the treatment of PTSD. Duncan maintains that PTSD should not be considered a static disorder but rather she encourages AAM providers to view those affected by trauma as survivors on a response spectrum. Recognizing these variations makes TCM modalities safe to deliver and implement in large health care facilities and most importantly carry a high level of patient satisfaction. That being said, despite efficacious evidence, mind-body approaches warrant more high-quality, larger sample size studies to ensure their utilization in the treatment of PTSD. Lastly, understanding these nuances can foster better understanding of patients exposed to trauma and through the implementation of trauma-informed care, may enhance treatment outcomes in TCM interventions clinically and lend a global credibility to TCM approaches in the treatment of PTSD.
